Attached gingiva: histology and surgical augmentation

The keratinized attached gingiva provides the periodontium with increased resistance to external injury, contributes to the stabilization of the gingival margin, and aids in dissipating physiological forces exerted by the muscular fibers of the alveolar mucosa on the gingival tissues. Increasing attached gingiva should be strongly considered in cases where the patient's plaque control is compromised. The apically positioned flap, free gingival graft, and subepithelial connective tissue graft are the most common surgical procedures used for augmenting the zone of attached gingiva effectively and predictably. The newly obtained keratinized gingiva can be maintained for a long period; in addition, these periodontal procedures halt the progression of gingival recession and could lead to gaining more keratinized gingiva from creeping attachment after the surgery. This article reviews the biology of attached gingiva and presents cases related to the functional role of periodontal plastic surgery.